|
Osteotomy, shortening, angular or rotational correction proximal phalanx, first toe (separate proce
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 28310
|
| Hospital Charge Code |
36028310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Osteotomy, shortening, angular or rotational correction proximal phalanx, first toe (separate proce
|
Facility
|
IP
|
$14,352.00
|
|
|
Service Code
|
HCPCS 28310
|
| Hospital Charge Code |
9900512
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$9,759.36
|
|
|
Osteotomy, shortening, angular or rotational correction proximal phalanx, first toe (separate proce
|
Facility
|
OP
|
$14,352.00
|
|
|
Service Code
|
HCPCS 28310
|
| Hospital Charge Code |
9900512
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$9,759.36
|
| Rate for Payer: Cash Price |
$9,759.36
|
| Rate for Payer: Cash Price |
$9,759.36
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$10,333.44
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$10,333.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$10,333.44
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10,333.44
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Osteotomy, tarsal bones, other than calcaneus or talus
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 28304
|
| Hospital Charge Code |
36028304
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Osteotomy, tarsal bones, other than calcaneus or talus
|
Facility
|
OP
|
$14,352.00
|
|
|
Service Code
|
HCPCS 28304
|
| Hospital Charge Code |
9900508
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$9,759.36
|
| Rate for Payer: Cash Price |
$9,759.36
|
| Rate for Payer: Cash Price |
$9,759.36
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$10,333.44
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$10,333.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$10,333.44
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10,333.44
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Osteotomy, tarsal bones, other than calcaneus or talus
|
Facility
|
IP
|
$14,352.00
|
|
|
Service Code
|
HCPCS 28304
|
| Hospital Charge Code |
9900508
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$9,759.36
|
|
|
Osteotomy; tibia
|
Facility
|
OP
|
$27,265.32
|
|
|
Service Code
|
HCPCS 27705
|
| Hospital Charge Code |
990969
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,116.01 |
| Max. Negotiated Rate |
$19,631.03 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$3,116.01
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$18,540.42
|
| Rate for Payer: Cash Price |
$18,540.42
|
| Rate for Payer: Cash Price |
$18,540.42
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$19,631.03
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$19,631.03
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$19,631.03
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$19,631.03
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Osteotomy; tibia
|
Facility
|
IP
|
$27,265.32
|
|
|
Service Code
|
HCPCS 27705
|
| Hospital Charge Code |
990969
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$18,540.42
|
|
|
Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatars
|
Facility
|
IP
|
$14,352.00
|
|
|
Service Code
|
HCPCS 28306
|
| Hospital Charge Code |
9900509
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$9,759.36
|
|
|
Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatars
|
Facility
|
OP
|
$18,794.85
|
|
|
Service Code
|
HCPCS 28307
|
| Hospital Charge Code |
9900510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$12,780.50
|
| Rate for Payer: Cash Price |
$12,780.50
|
| Rate for Payer: Cash Price |
$12,780.50
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$13,532.29
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$13,532.29
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$13,532.29
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$13,532.29
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatars
|
Facility
|
IP
|
$18,794.85
|
|
|
Service Code
|
HCPCS 28307
|
| Hospital Charge Code |
9900510
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$12,780.50
|
|
|
Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatars
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 28306
|
| Hospital Charge Code |
36028306
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatars
|
Facility
|
OP
|
$15,408.22
|
|
|
Service Code
|
CPT 28307
|
| Hospital Charge Code |
36028307
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatars
|
Facility
|
OP
|
$14,352.00
|
|
|
Service Code
|
HCPCS 28306
|
| Hospital Charge Code |
9900509
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,398.52 |
| Max. Negotiated Rate |
$15,408.22 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$2,398.52
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Amerigroup Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX Blue Advantage |
$9,989.86
|
| Rate for Payer: BCBS of TX Blue Essentials |
$11,963.90
|
| Rate for Payer: BCBS of TX Medicare |
$7,289.28
|
| Rate for Payer: BCBS of TX PPO |
$15,074.51
|
| Rate for Payer: Cash Price |
$9,759.36
|
| Rate for Payer: Cash Price |
$9,759.36
|
| Rate for Payer: Cash Price |
$9,759.36
|
| Rate for Payer: Cigna Commercial |
$15,408.22
|
| Rate for Payer: Cigna Medicaid |
$10,333.44
|
| Rate for Payer: Cigna Medicare |
$7,289.28
|
| Rate for Payer: Employer Direct Commercial |
$7,289.28
|
| Rate for Payer: Humana Medicare/TRICARE |
$7,289.28
|
| Rate for Payer: Molina CHIP/Medicaid |
$10,333.44
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Molina Medicare |
$7,289.28
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$10,333.44
|
| Rate for Payer: Scott and White EPO/PPO |
$13,485.17
|
| Rate for Payer: Scott and White Medicare |
$7,289.28
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$10,333.44
|
| Rate for Payer: Superior Health Plan EPO |
$7,289.28
|
| Rate for Payer: Superior Health Plan Medicare |
$7,289.28
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$7,289.28
|
| Rate for Payer: Universal American Medicare |
$7,289.28
|
| Rate for Payer: Wellcare Medicare |
$7,289.28
|
| Rate for Payer: Wellmed Medicare |
$7,289.28
|
|
|
Osteotomy, with or without lengthening, shortening or angular correction, metatarsal other than fir
|
Facility
|
OP
|
$7,076.00
|
|
|
Service Code
|
HCPCS 28308
|
| Hospital Charge Code |
9900511
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cash Price |
$4,811.68
|
| Rate for Payer: Cash Price |
$4,811.68
|
| Rate for Payer: Cash Price |
$4,811.68
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicaid |
$5,094.72
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$5,094.72
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Parkland Medicaid |
$5,094.72
|
| Rate for Payer: Scott and White EPO/PPO |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$5,094.72
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Osteotomy, with or without lengthening, shortening or angular correction, metatarsal other than fir
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
CPT 28308
|
| Hospital Charge Code |
36028308
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,088.27 |
| Max. Negotiated Rate |
$10,000.00 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1,088.27
|
| Rate for Payer: Amerigroup Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Amerigroup Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4,571.54
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5,474.90
|
| Rate for Payer: BCBS of TX Medicare |
$3,286.91
|
| Rate for Payer: BCBS of TX PPO |
$6,898.37
|
| Rate for Payer: Cigna Commercial |
$6,947.94
|
| Rate for Payer: Cigna Medicare |
$3,286.91
|
| Rate for Payer: Employer Direct Commercial |
$3,286.91
|
| Rate for Payer: Humana Medicare/TRICARE |
$3,286.91
|
| Rate for Payer: Molina Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Molina Medicare |
$3,286.91
|
| Rate for Payer: Multiplan Auto |
$10,000.00
|
| Rate for Payer: Multiplan Commercial |
$10,000.00
|
| Rate for Payer: Multiplan Workers Comp |
$10,000.00
|
| Rate for Payer: Scott and White EPO/PPO |
$6,080.78
|
| Rate for Payer: Scott and White Medicare |
$3,286.91
|
| Rate for Payer: Superior Health Plan EPO |
$3,286.91
|
| Rate for Payer: Superior Health Plan Medicare |
$3,286.91
|
| Rate for Payer: Universal American Dual Medicare/Medicaid |
$3,286.91
|
| Rate for Payer: Universal American Medicare |
$3,286.91
|
| Rate for Payer: Wellcare Medicare |
$3,286.91
|
| Rate for Payer: Wellmed Medicare |
$3,286.91
|
|
|
Osteotomy, with or without lengthening, shortening or angular correction, metatarsal other than fir
|
Facility
|
IP
|
$7,076.00
|
|
|
Service Code
|
HCPCS 28308
|
| Hospital Charge Code |
9900511
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,811.68
|
|
|
Ostomy bag replacement only, each
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS A4363
|
| Hospital Charge Code |
994102
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$76.16
|
|
|
Ostomy bag replacement only, each
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS A4363
|
| Hospital Charge Code |
994102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$10.08
|
| Rate for Payer: BCBS of TX Blue Advantage |
$3.99
|
| Rate for Payer: BCBS of TX Blue Essentials |
$4.79
|
| Rate for Payer: BCBS of TX PPO |
$5.31
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cigna Medicaid |
$80.64
|
| Rate for Payer: Molina CHIP/Medicaid |
$80.64
|
| Rate for Payer: Multiplan Auto |
$72.80
|
| Rate for Payer: Multiplan Commercial |
$72.80
|
| Rate for Payer: Multiplan Workers Comp |
$72.80
|
| Rate for Payer: Parkland Medicaid |
$80.64
|
| Rate for Payer: Scott and White EPO/PPO |
$56.00
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$80.64
|
| Rate for Payer: Superior Health Plan EPO |
$15.23
|
|
|
OST PASTE STMA -- DHF
|
Facility
|
IP
|
$17.36
|
|
| Hospital Charge Code |
80331457
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$11.80
|
|
|
OST PASTE STMA -- DHF
|
Facility
|
OP
|
$17.36
|
|
| Hospital Charge Code |
80331457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$12.50 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.56
|
| Rate for Payer: BCBS of TX Blue Advantage |
$5.21
|
| Rate for Payer: BCBS of TX Blue Essentials |
$6.25
|
| Rate for Payer: BCBS of TX PPO |
$6.94
|
| Rate for Payer: Cash Price |
$11.80
|
| Rate for Payer: Cigna Medicaid |
$12.50
|
| Rate for Payer: Molina CHIP/Medicaid |
$12.50
|
| Rate for Payer: Multiplan Auto |
$11.28
|
| Rate for Payer: Multiplan Commercial |
$11.28
|
| Rate for Payer: Multiplan Workers Comp |
$11.28
|
| Rate for Payer: Parkland Medicaid |
$12.50
|
| Rate for Payer: Scott and White EPO/PPO |
$8.68
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$12.50
|
| Rate for Payer: Superior Health Plan EPO |
$2.36
|
|
|
OST SKIN BOND -- DHF
|
Facility
|
OP
|
$367.82
|
|
| Hospital Charge Code |
80332000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.10 |
| Max. Negotiated Rate |
$264.83 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$33.10
|
| Rate for Payer: BCBS of TX Blue Advantage |
$110.35
|
| Rate for Payer: BCBS of TX Blue Essentials |
$132.42
|
| Rate for Payer: BCBS of TX PPO |
$147.13
|
| Rate for Payer: Cash Price |
$250.12
|
| Rate for Payer: Cigna Medicaid |
$264.83
|
| Rate for Payer: Molina CHIP/Medicaid |
$264.83
|
| Rate for Payer: Multiplan Auto |
$239.08
|
| Rate for Payer: Multiplan Commercial |
$239.08
|
| Rate for Payer: Multiplan Workers Comp |
$239.08
|
| Rate for Payer: Parkland Medicaid |
$264.83
|
| Rate for Payer: Scott and White EPO/PPO |
$183.91
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$264.83
|
| Rate for Payer: Superior Health Plan EPO |
$50.02
|
|
|
OST SKIN BOND -- DHF
|
Facility
|
IP
|
$367.82
|
|
| Hospital Charge Code |
80332000
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$250.12
|
|
|
OST SKIN PROTEC -- DHF
|
Facility
|
OP
|
$16.54
|
|
| Hospital Charge Code |
80332257
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Amerigroup CHIP/Medicaid |
$1.49
|
| Rate for Payer: BCBS of TX Blue Advantage |
$4.96
|
| Rate for Payer: BCBS of TX Blue Essentials |
$5.95
|
| Rate for Payer: BCBS of TX PPO |
$6.62
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna Medicaid |
$11.91
|
| Rate for Payer: Molina CHIP/Medicaid |
$11.91
|
| Rate for Payer: Multiplan Auto |
$10.75
|
| Rate for Payer: Multiplan Commercial |
$10.75
|
| Rate for Payer: Multiplan Workers Comp |
$10.75
|
| Rate for Payer: Parkland Medicaid |
$11.91
|
| Rate for Payer: Scott and White EPO/PPO |
$8.27
|
| Rate for Payer: Superior Health Plan CHIP/Medicaid |
$11.91
|
| Rate for Payer: Superior Health Plan EPO |
$2.25
|
|
|
OST SKIN PROTEC -- DHF
|
Facility
|
IP
|
$16.54
|
|
| Hospital Charge Code |
80332257
|
|
Hospital Revenue Code
|
272
|
| Rate for Payer: Cash Price |
$11.25
|
|
